Published in PLOS One on 2026-06-01, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Desalegn Shiferaw, Mohammed Sanni Ali, Fasil Tessema, Bikila Regassa Feyisa, Mubarek Yesse Ashemo, Assefa Legesse Sisay, Muluemebet Abera, Tizta Tilahun Degfie, Esayas Alemayehu, Chaltu Fikru, Yohannes Kebede, Lelisa Sena Dadi
Source: PLOS One • DOI 10.1371/journal.pone.0349572
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Irrespective of intensive global efforts to reduce under-five mortality, it remains a significant public health concern. Understanding the causes and trends of under-five mortality is essential for guiding targeted interventions, assessing the effectiveness of public health strategies, and monitoring changes in mortality over time. The health and demographic surveillance system is one of the preferred sources to study the cause of under-five mortality.
This study aims to analyse the causes and trends of under-five deaths in Southwest Ethiopia using Gilgel-Gibe Health and Demographic Surveillance System (GGHDSS) database.
GGHDSS is an open, dynamic cohort that was established in 2005. Fifteen years of mortality data and seven years of Verbal Autopsy (VA) data were extracted from the GGHDSS database for this study. The VA data are part of the fifteen year mortality dataset, in which causes of death were determined through the VA method. After extracting the data from MYSQL and OpenHDS, it was exported to Excel for further cleaning. Finally, the cleaned data were exported to R statistical software for analysis and visualization. Neonatal, infant, and under-five mortality trends were analysed and the proportion of cause specific deaths were identified from the VA data.
Between 2005 and 2019, 28, 811 children, 13931 (48.35%) female and 14880 (51.65%) male, were born alive and registered in the GGHDSS, among which 1828 (6.34%) of them died before celebrating their fifth birthday. The overall under-five mortality rate was 63.4 (95% CIs; 60.6, 66.3) per 1000 live births while neonatal and infant mortality rates were 30(95% CIs; 28.1, 32) and 50.2 (95% CIs; 47.6, 52.7), respectively. The mortality rate during the surveillance years showed a declining trend among neonatal, infant, and overall under-five children, with average slopes of −2.49, −4.56, and −7.24, respectively. From 1070 under-five deaths captured by the VA method in GGHDSS during 2009–2016, 596 (55.7%) were male and 474 (44.30%) were female. The most common causes of neonatal death were birth asphyxia and perinatal respiratory disorders, bacterial sepsis, and prematurity including respiratory distress. In the post-neonatal period, the most common causes of death were acute lower respiratory infections (including pneumonia and acute bronchitis), intestinal infectious diseases including diarrheal diseases, and malaria. Severe malnutrition, intestinal infectious diseases, and acute lower respiratory infections were responsible for more than half of the deaths among children between 12 and 59 months of age.
Under-five mortality has shown a significant declining trend between 2005 and 2019 at the study setting. Birth asphyxia, neonatal infections, and prematurity were among the most common causes of neonatal deaths, whereas infectious diseases and malnutrition were the main causes of death beyond the neonatal period. Strengthening perinatal and neonatal care, improving prevention and management of childhood infections, and enhancing early nutritional interventions are needed to reduce under-five mortality.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Desalegn Shiferaw, Mohammed Sanni Ali, Fasil Tessema, Bikila Regassa Feyisa, Mubarek Yesse Ashemo, Assefa Legesse Sisay, Muluemebet Abera, Tizta Tilahun Degfie, Esayas Alemayehu, Chaltu Fikru, Yohannes Kebede, Lelisa Sena Dadi. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Incidence of mortality and its predictors among low birth weight neonates in Ethiopia: Systematic review and meta-analysis
- Evidence brief: Assessment of trends and determinants of under-five mortality among children born to older women: Evidence from Ethiopian demographic and health surveys
- Evidence brief: Neonatal survival and mortality predictors among low-birth-weight neonates: A Retrospective cohort study from Suhul Hospital, northern Ethiopia
